Comparison of conventional radiography combined with ultrasonography versus nonenhanced helical computed tomography in evaluation of patients with renal colic

The aim of this study is to determine whether kidneys ureters bladder X-ray (KUB) film combined with ultrasound (US) can be effectively used in evaluation of renal colic and miss stones with clinically significant size identified on nonenhanced computed tomography (NECT) in patients with urolithiasis. This retrospective study evaluated the clinical and radiological records of 300 patients at our institution undergoing KUB and/or US and/or NECT for the evaluation of renal colic from June 2007 to December 2010. Of patients with negative findings on KUB and/or US, 22 had renal stones on NECT (mean size 4.4?mm, range 3-8), 3 had lower ureteral stone (mean size 3.3?mm, range 2-5). In patients with isolated suspicious renal ectasia without stone image, two had renal stone on NECT (mean size 4?mm, range 2-6), 5 had upper ureteral stone (mean size 4.4?mm, range 4-6), 7 had middle ureteral stone (mean size 3.7?mm, range 3-4) and 14 had lower ureteral stone (mean size 4?mm, range 2-6). The cost-effective and almost radiation-free combination of KUB and US should be preferred for diagnosis of urolithiasis, as it detects most of the ureteral and renal calculi which are clinically significant.     

Acupuncture in the treatment of renal colic.

A prospective randomized study was performed to compare the effect of acupuncture and intramuscular Avafortan injection in the treatment of renal colic. Our results showed that acupuncture is as effective in relieving renal colic as Avafortan but it had a more rapid analgesic onset (3.14 +/- 2.88 minutes versus 15.44 +/- 7.55 minutes, p less than 0.05). Of the patients in the Avafortan group 7 (43.8%) had side effects, including skin rash in 3, tachycardia in 2, drowsiness in 1 and facial flush in 1. No side effects were noted in the acupuncture group. During 2 hours of observation acupuncture and Avafortan seemed to be ineffective in promoting stone passage. However, patients receiving Avafortan treatment were more likely to have paralytic ileus. In summary, acupuncture can be a good alternative for the treatment of renal colic.     

Critical prospective appraisal of renal morphology and function in children undergoing shockwave lithotripsy and percutaneous nephrolithotomy

PURPOSE: To assess the effect of shockwave lithotripsy (SWL) and percutaneous nephrolithotomy (PCNL) on renal morphology and function in children undergoing therapy for upper-tract urolithiasis. PATIENTS AND METHODS: Fourteen patients less than 13 years of age with renal or upper-ureteral calculi who were found suitable for primary SWL or PCNL were evaluated for alteration of renal morphology and function after treatment. Of the 18 renal units treated, SWL and PCNL were performed in 9 units each. The average stone size was 880.2 mm2 (range 110-3800 mm2; median 660 mm2). All children underwent ultrasonic estimation of renal length and parenchymal thickness, 99m technetium dimercaptosuccinic acid (DMSA) and 99m Tc-ethylene dicystine (EDC) scintigraphy, and glomerular filtration rate (GFR) estimation prior to intervention and at 3 and 6 months of follow-up. RESULTS: Extracorporeal lithotripsy achieved complete clearance in 8 renal units (88%), requiring an average of 6333 shockwaves and an average of 2.2 sessions per renal unit. The efficiency quotient was 42. Percutaneous surgery likewise achieved complete stone clearance in 88% of renal units, with three units requiring more than one tract. Mixed calcium oxalate monohydrate and dihydrate accounted for the majority of the stones. The mean preintervention GFR was 78.3 +/- 14.6 mL/min/1.73 m2 (median 82.5 mL/min/1.73 m2; range 54-98.6 mL/min/1.73 m2), whereas the mean GFR at 3 months was 78.95 +/- 14.4 mL/min/1.73 m2 (median 78.95 mL/min/1.73 m2; range 52-98 mL/min/1.73 m2). A marginal improvement of an average of 0.65 mL/min was noted. Split function EDC scans demonstrated improved drainage in five cases after intervention; the rest were unchanged. Preintervention DMSA scans revealed renal cortical scars in three children. None of the renal units had developed fresh scars at follow-up scans. None of the children developed new-onset hypertension, proteinuria, or alteration in renal size. CONCLUSION: In the present study, pediatric SWL and PCNL were not found to cause adverse renal morphologic or functional alteration. Stone clearance resulted in marginally improved function and better drainage.     

Emergency extracorporeal shockwave lithotripsy for acute renal colic caused by upper urinary-tract stones

PURPOSE: To evaluate emergency SWL for the treatment of upper urinary-tract stones causing renal colic. PATIENTS AND METHODS: Between January 1999 and June 2003, 53 patients with a mean age of 46.6 years (range 22-65 years) were enrolled. The inclusion criteria were acute renal colic, radiopaque 5-mm to 1.5-cm calculi in the ureteropelvic junction (N=10) or upper ureter (N=43), and no evidence of urinary-tract infection or acute renal failure. The mean stone size was 7.14 mm (range 5-13 mm). Patients were randomly assigned to the control (N=28) and study (N=25) groups using previously prepared cards in envelopes. Patients in the study group underwent emergency SWL, while patients in the control group underwent scheduled SWL within 30 days. Stone status was evaluated 4 weeks after lithotripsy. There was no significant difference between the control and study groups with respect to age, sex, stone location or volume, renal obstruction, or days spent in the hospital for pain control. Available fragments of stones were sent for infrared spectroscopy. Preoperative and postoperative data were compared in the two groups using SPSS 10.0 statistical software. RESULTS: The SWL treatment lasted 50+/-11 minutes. The stone-free rates were 72% and 64% and the efficiency quotients were 53% and 44% in study and control groups, respectively. Patients in the control group spent more time in the hospital (P=0.014) and in recovery at home (P=0.011). CONCLUSION: Emergency SWL for acute renal colic caused by upper-ureteral stones is a safe procedure and offers effective release from pain and obstruction. It also decreases hospitalization days and hastens return to normal activity.     

Local active warming: an effective treatment for pain,anxiety and nausea caused by renal colic

PURPOSE: Based on previous studies showing that warming decreases trauma pain in emergency care we hypothesized that local active warming of the abdomen and lower back region could decrease pain in acute renal colic cases during emergency transport. MATERIALS AND METHODS: After obtaining informed consent 100 patients were divided into 2 groups, including those who received active warming of the abdomen and lower back region (42C) and those who received no warming. Pain, nausea and anxiety were rated by the patients using visual analog scales. Statistical evaluation was performed using the t test with p <0.05 considered significant. RESULTS: In group 1 a significant pain decrease was recorded in all cases using a visual analog score (VAS) (82.7 +/- 9.5 to 36.3 +/- 16.0 mm VAS, p <0.01). In group 2 patient pain scores remained comparable (81.8 +/- 13.0 to 80.6 +/- 12.3 mm VAS). In group 1 anxiety significantly decreased (79.0 +/- 8.9 and 30.7 +/- 14.1 mm VAS before and after treatment, respectively, p <0.01). In group 2 a nonsignificant change in score was noted (79.7 +/- 20.5 to 75.2 +/- 19.7 mm VAS). In group 1 a significant decrease in nausea was recorded in all cases (85.7 +/- 11.2 to 40.6 +/- 23.0 mm VAS, p <0.01). In group 2 patient nausea scores remained comparable (79.2 +/- 22.0 to 80.3 +/- 22.4 mm VAS, respectively). CONCLUSIONS: Local active warming is an effective and easy to learn pain treatment for patients with acute renal colic in emergency care.     

Transcutaneous electrical nerve stimulation: an effective treatment for pain caused by renal colic in emergency care

PURPOSE: Acute renal colic is one of the most anguishing forms of pain in humans. We hypothesized that TENS is an effective pain treatment in patients with acute renal colic. MATERIALS AND METHODS: A total of 100 patients with acute flank pain and suspected renal colic consented to participate in our study. Paramedic 1 recorded baseline parameters at the emergency site and at the end of transportation. Paramedic 2 performed TENS in patients randomly assigned to G1 with actual TENS or to G2 with sham TENS. Pain and anxiety were measured using paper based visual analog scales on a scale of 0 to 100 mm. RESULTS: Of 100 screened patients 73 had renal colic, including 39 in G1 and 34 in G2. There was no significant difference with regard to potentially influencing factors, such as patient age, sex, weight, height, blood pressure and heart rate, pain, nausea and anxiety between the groups before treatment. G1 showed a significant mean pain decrease +/- SD of more than 50% (85.7 +/- 10.5 to 33.3 +/- 16.0 mm, p <0.01). G2 showed no variation in mean pain scores (85.8 +/- 18.0 to 82.6 +/- 14.3 mm). G1 showed changes in the mean anxiety score (69.0 +/- 8.4 to 37.7 +/- 15.1 mm, p <0.01), nausea score (90.7 +/- 9.2 to 44.9 +/- 22.0 mm) and heart rate (92 +/- 10 to 64 +/- 8 bpm), while G2 showed nonsignificant changes. CONCLUSIONS: This trial shows that local TENS is a rapid and effective treatment for renal colic pain. We found TENS to be a good nondrug therapy under the difficult circumstances of out of hospital rescue.     

The role of extracorporeal shockwave lithotripsy in an asymptomatic special patient group with small renal calculi

BACKGROUND AND PURPOSE: Data concerning extracorporeal shock wave lithotripsy (SWL) management of small (< or = 5 mm) asymptomatic renal caliceal stones are lacking in the literature. In this study, we aimed to determine the effectiveness of SWL in a special group of patients who had very small (< or = 5 mm) asymptomatic renal caliceal stones. The group of patients consisted of pilots, gendarmes, and soldiers, such as commandos, for whom treatment was obligatory and who had to be stone free because of their military duties. PATIENTS AND METHODS: We retrospectively examined SWL data and retrieved information for 84 patients with small asymptomatic renal caliceal stones. The SWL sessions were performed with a Siemens Lithostar lithotriptor. The mean age of the patients was 34 +/- 13 years. The mean stone size was 4.8 +/- 0.4 mm. The mean numbers of shockwaves and energy used were 2707 +/- 1742 and 18 +/- 2 kV, respectively. The location of stones were: 11 right upper calix, 10 right middle calix, 17 right lower calix, 13 left upper calix, 16 left middle calyx, and 17 left lower calix. Eighty-four patients underwent 101 SWL sessions. Only eight patients had second and three patients had third SWL treatments. SWL was performed five times for only one patient. All mean values were realized with an SPSS 10.0 statistical program. RESULTS: After the first, second, and third SWL sessions, the stone-free rate was calculated as 87%, 93% and 94%, respectively. Only five patients with lower renal caliceal stones were not stone free. The reported complications were macroscopic hematuria necessitating medical attention in four patients, skin ecchymosis in seven patients, severe colic pain in two patients, and urinary-tract infection in one patient. There was no need for hospitalization for these complications. CONCLUSION: SWL is effective and safe in patients with very small (< or = 5 mm) asymptomatic renal caliceal stones in all locations.     

Rapid extracorporeal shock wave lithotripsy treatment after a first colic episode correlates with accelerated ureteral stone clearance

OBJECTIVES: To investigate the relationship between delay in extracorporeal shock wave lithotripsy (ESWL) after a first colic and subsequent time to complete stone clearance. METHODS: This prospective, non-randomized study included 94 patients treated with ESWL for unilateral solitary proximal ureteral stones after at least one episode of colic pain. Time between the first onset of colic pain and ESWL and stone clearance was recorded. The pretherapeutic degree of hydronephrosis has been assessed using ultrasound. RESULTS: Mean stone size was 7.9 +/- 2.3 mm and mean time before ESWL after a first colic was 93.4 +/- 143.5 h. At 3 months, 3 patients were lost to follow-up. In 76.9% of patients stones were completely cleared and a further 3.3% harbored residual fragments < or =3 mm. Delay in treatment after a first colic correlated with subsequent time to stone clearance (p < 0.0001). Mean time to stone clearance in patients treated within 24h was 6.4 +/- 6.3 days compared with 16.0 +/- 17.8 days for those treated later (p = 0.008). Maximum stone diameter correlated with time to stone clearance (p = 0.031), but the degree of hydronephrosis did not. CONCLUSIONS: Rapid ESWL after a first onset of colic pain resulted in accelerated stone clearance independent of the degree of hydronephrosis but had no impact on the need for auxiliary procedures.     

Teleradiology in orthopaedics

Teleradiology is a means of electronically transmitting radiographic image files from one location to another. Technologic advances in digital imaging, telecommunications, digital storage, and viewing technologies have made teleradiology readily available and reasonably affordable. The five components of a teleradiology system include: a sending station, a transmission network, a storage device, a viewing station and, a software package. The advantage of teleradiology is the mobility of digital images. In contrast to plain radiographs that only can be seen in one location at a time, multiple persons who are at different locations can view digital images simultaneously. When applied to orthopaedic trauma applications, when the consulting orthopaedist is at a remote location from the patient, teleradiology has been shown to improve diagnostic accuracy, disposition planning of patients from emergency departments or outlying hospitals, and planning of surgical procedures. These systems also improve the comfort level of consulting orthopaedic surgeons and potentially limit the risk of litigation for incorrect diagnosis. The quality, convenience, and effectiveness of teleradiology systems should improve as the technologies continue to mature. Having radiographic images available on handheld devices, such as cell phones, is likely to be a reality in the near future.     

Forced versus minimal intravenous hydration in the management of acute renal colic: a randomized trial

BACKGROUND AND PURPOSE: The management of acute renal colic is a problem commonly encountered by both urologists and emergency medicine physicians. The classic approach to managing uncomplicated acute renal colic involves hydration, along with imaging and pain control. Previous studies have suggested that hydration has a significant impact on patient comfort, as well as spontaneous stone passage. This study evaluated the effects of maintenance v forced hydration and its effect on the pain experienced from renal colic. PATIENTS AND METHODS: Forty male and 18 female patients with a mean age of 41 years suspected to have acute renal colic were identified in the emergency department. After screening and informed consent, the patients were enrolled in the study, and 43 patients were eventually available for analysis. Patients received intravenous (IV) analgesia, imaging with a noncontrast CT scan of abdomen and pelvis, and assignment to either forced IV hydration with 2 L of normal saline over 2 hours (N = 20) or minimal IV hydration at 20 mL of normal saline per hour (N = 23). A visual analog pain scale was completed hourly for a total of 4 hours. Demographic information, laboratory and imaging results, narcotic use in morphine equivalents (ME), and pain scores were recorded and compared. Spontaneous stone passage rates were also calculated by careful patient follow-up. Results were considered statistically significant at p < 0.05. RESULTS: Stone size was equivalent in the two treatment groups (p > 0.05). There was no difference in the narcotic requirement in ME (p = 0.644) between the two groups. Similarly, there was no difference in hourly pain score or stone-passage rates between the groups (p > 0.05). CONCLUSIONS: Treatment of uncomplicated renal colic has traditionally included vigorous intravenous hydration, as well as medications for the control of pain and nausea. Our data suggest that maintenance intravenous fluids are as efficacious as forced hydration with regard to patient pain perception and narcotic use. Moreover, it appears the state of hydration has little impact on stone passage.     

患肾不显影输尿管结石的ESWL治疗

目的　总结由输尿管结石梗阻引起患侧肾脏不显影者行ESWL治疗的临床经验。　方法　输尿管结石致急性绞痛患者 16 8例 ,ESWL术前行KUB和IVU检查明确诊断输尿管结石而患侧肾脏不显影。结石位于髂骨缘以上者采用仰卧位 ,髂骨缘以下者采用俯卧位治疗。对 10 4例病史 <1个月、年龄 <6 0岁者于结石排空后行IVU ,观察其肾功能恢复情况。　结果　 16 8例患者全部于 2周内排空结石 ,其中 10 4例在结石排空后 1周～ 1年复查IVU ,患侧肾均已显影 ,2例仍有肾盂轻度积水。　结论　输尿管结石急性发病时 ,可因肾内压力骤增而引起肾功能受损 ,表现为患侧肾不显影。这种损害是可逆的 ,及时解除梗阻可使患肾功能得到恢复 ,ESWL是有效措施之一     

The presence of microscopic hematuria detected by urine dipstick test in the evaluation of patients with renal colic

Urolithiasis is a common diagnosis in patients presenting at our hospital with flank pain. One of the most important steps in the diagnostic algorithm of renal colic is the presence of hematuria, but this fact has been challenged by authors reporting a negative urinalysis for microscopic hematuria in about 9–18% of such patients. Our aim was to investigate whether the same results are obtained when a sample of urine is tested with a urine dipstick test (UDT) at the time of the initial examination. Data from patients with the clinical diagnosis of renal colic examined at the emergency department of our hospital were reviewed, and the sensitivity of hematuria in urine samples tested by UDT was recorded in a group consisting of patients for whom imaging showed evidence of a stone >3 mm in size. In cases in which UDT was negative, or showed only traces of red blood cells (RBCs), a formal urinalysis was performed. A total of 609 patients were finally included in the study, with a mean age of 49.2 years. Average stone size was 5.8 mm, located mainly in the lower part of the ureter. Dipstick analysis was positive for hematuria in 92.9%. A urinalysis, with a cut-off point of less than three red blood cells per high power field, was used as a means to verify the results of the UDT in 17.8% of cases: in 7.1% of UDT negative patients and 10.7% of patients with traces of blood. The urinalysis was negative in 5.1% of patients, adding only 2% to the diagnostic accuracy of UDT. Therefore, our findings suggest that the sensitivity of a UDT for hematuria in cases of suspected renal colic has a high degree of accuracy when performed at the emergency department, and can be used as a first-line, low cost examination. A microscopic analysis may be useful when the UDT is negative or not clear enough, to verify the results.     

Correlation of ureteral stone measurements by CT and plain film radiography: utility of the KUB

BACKGROUND AND PURPOSE: The practice of utilizing helical CT to evaluate patients suspected of renal colic is increasing. Little is known about the accuracy of CT in estimating stone size or the utility of an accompanying plain abdominal radiograph (KUB film). The purpose of our study was to compare ureteral stone size estimation by helical CT and plain film and determine whether a KUB film provides additional information useful in patient management. PATIENTS AND METHODS: Thirty consecutive patients (17 male, 13 female) having both a helical CT and a KUB study for evaluation of renal colic secondary to ureteral calculi comprised the study population. Calculus number, location, and dimensions were determined from these images. Stone dimensions were measured using electronic calipers on a picture archiving and communications system. Information found by KUB and CT was compared, and both sets of stone measurements were correlated with patient outcome. RESULTS: The mean maximal stone transverse diameter and length were similar on CT and plain film: 5.8 mm v 5.8 mm and 9.5 mm v 8.9 mm, respectively (P = 0.57 and 0.29, respectively). The mean anteroposterior stone diameter on CT of 6.8 mm was statistically greater than the transverse diameter as measured by both CT and KUB, which were 5.8 mm and 5.8 mm (P = 0.0002 and 0.0007, respectively). Eleven patients spontaneously passed their stones, while 19 patients required intervention. Patient outcome, as predicted by transverse stone width, was similar for CT and KUB data. CONCLUSIONS: The management of patients with ureteral calculi relies on estimated stone size and the stone's potential for spontaneous passage. Stone dimensions estimated by CT are similar to the size determined by plain film radiography. Although plain film radiography does not provide information on stone dimensions beyond that obtained with CT, it does reveal precise stone location and radiolucency, data helpful in following and treating patients.     

Prostaglandin synthetase inhibition of renal pelvic smooth muscle in the rabbit

The prostaglandin synthetase inhibitors diclofenac and indomethacin relieve pain in renal colic probably by decreasing renal pelvic pressure. Decreased diuresis and effects on the oedema around the obstructing stone are plausible explanations. In the present study on rabbit renal pelvic tissue strips it was found that both indomethacin and diclofenac decreased the spontaneous phasic activity of the strips. ED50 was 5.4 +/- 0.7 X 10(-5) M for indomethacin and 2.4 +/- 0.5 X 10(-5) M for diclofenac (P less than 0.001). With the prostaglandin synthetase inhibitors still in the tissue bath the activity was regained when either prostaglandin E2 or F2 alpha was added, prostaglandin E2 being more potent in this respect. It was concluded that prostaglandin synthetase inhibitors seem to reduce smooth muscle activity in the renal pelvis, a mechanism which might contribute to the pain-relieving ability of these drugs in renal colic.     

Rapid extracorporeal shock wave lithotripsy for proximal ureteral calculi in colic versus noncolic patients

OBJECTIVES: In delayed extracorporeal shock wave lithotripsy (ESWL) treatment, increasing stone impaction is associated with delayed stone clearance. Whether colic patients treated by rapid ESWL have the same time to stone clearance as noncolic patients, which supports the thesis that stones in both groups are nonimpacted, has not been investigated yet, and was the objective of this study. METHODS: A total of 82 patients were prospectively enrolled and treated with piezoelectric ESWL for a solitary proximal ureteral stone. Of these, 56 patients experienced at least one colic episode compared with 26 noncolic patients. Hydronephrosis has been assessed with the use of ultrasound and intravenous urography (IVU). Time to stone clearance after the first ESWL and stone-free rates after a follow-up period of 3 mo were recorded. RESULTS: In colic and noncolic patients, mean stone size was 7.8mm (p=0.7). Ultrasound-detected hydronephrosis was present in 88% versus 39% (p<0.0001), whereas IVU-detected hydronephrosis was present in 60% versus 7.7% (p=0.0001). Mean number of impulses applied was 8000+/-4000 versus 6700+/-3400 (p=0.1). Mean time to stone clearance was 9.5+/-12.1 d versus 4.6+/-3.8 d (p=0.1). Colic and noncolic patients were considered as treatment success in 83% and 81% after 3 mo of follow-up (p=0.9). CONCLUSIONS: Treatment outcome and time to stone clearance after rapid ESWL in colic patients compared with noncolic patients is comparable and independent of concomitant hydronephrosis. This finding suggests an absence of significant impaction in proximal ureteral stones treated within 24h after a first colic episode, enforcing the concept of performing rapid ESWL in patients harbouring proximal ureteral stones.     

64层螺旋CT平扫曲面重建技术对急性输尿管结石的诊断价值

目的：探讨64层螺旋CT曲面重建（CPR）技术对急性输尿管结石的诊断价值。方法：35例疑为输尿管结石的患者,男24例,女11例,年龄23-79岁,均行B超和64层螺旋CT平扫检查,将CT原始资料传送至工作站,用多平面重建（MPR）及CPR技术进行图像后处理,比较CT与B超诊断输尿管结石的阳性率。结果：35例输尿管结石患者中,CT诊断输尿管结石32例（91．4％）,B超诊断输尿管结石20例（57．1％）,CT对输尿管结石的诊断率高于B超（r=7．56,P〈0．01）;CPR使扩张的肾盂、输尿管全程显示在一幅图像上,便于全面观察结石的形态、大小和位置。结论：64层螺旋CT的CPR技术方便快捷、诊断准确率高,不需使用对比剂,尤其适用于肾绞痛患者的检查。     

Immediate versus deferred radiological investigation after acute renal colic: a prospective randomized study

OBJECTIVE: The timing of radiological assessment after acute renal colic is controversial. The aim of this study was to investigate the value of immediate versus deferred radiological imaging and to compare morbidity rates after an attack of acute renal colic. MATERIAL AND METHODS: Between September 2001 and December 2002 all 686 patients with acute renal colic attending our university hospital were registered. Of these, 172 patients rendered pain-free after analgesic injection were randomized to either immediate or deferred radiological investigation. All patients received a questionnaire encompassing questions on consumption of analgesics, impact of symptoms on normal daily activity (including working ability), need for additional emergency department visits and hospitalization. Stone treatments were registered. RESULTS: The incidence of renal colic was 0.9/1,000 inhabitants per year. In total, 74% of all patients became pain-free after analgesic injection. Morbidity was low among the randomized patients, and did not differ between the immediate or deferred radiological investigation groups. In both groups, the duration of impairment of normal daily activities and analgesic consumption was a median of 2 days. In the immediate group, 14% needed another emergency visit and 4% were hospitalized. Corresponding figures for the deferred group were 15% and 7%. In the immediate group, 17% had stone treatment, compared with 8% in the deferred group. CONCLUSION: For most patients with acute renal colic, parenteral analgesia resulted in complete symptom resolution. When initial medical treatment was successful, patient morbidity was low. In these patients, immediate radiological imaging did not lead to reduced morbidity compared with radiological imaging after 2-3 weeks.     

妊娠期顽固性肾绞痛的腔内处理

目的探讨腔内诊治妊娠期肾积水合并顽固性肾绞痛的安全性和有效性。 方法回顾性分析2017年3月至2018年9月我院收治的78例妊娠期肾积水合并顽固性肾绞痛患者的病例资料。根据顽固性肾绞痛持续时间将患者分为A组（6 h以内16例）,B组（6～12 h 53例）和C组（12 h以上9例）。 结果58例术中发现输尿管结石,16例（27.6%）术前彩超未见输尿管结石,行输尿管镜碎石取石和留置输尿管双J管。输尿管结石清除率87.9%（51/58）。20例未发现输尿管结石但合并肾盂结石患者,术中留置输尿管双J管。9例（11.5%）有先兆流产表现,其中A组1例（6.25%）,B组4例（7.55%）,C组4例（44.4%）。C组先兆流产的发生率高于A和B组（P<0.05）。1例（6.25%）患者出现尿源性脓毒血症,抗感染等对症处理后痊愈。所有患者均成功通过围产期并生产健康婴儿。 结论对于妊娠期肾积水合并顽固性肾绞痛的患者,早期输尿管镜腔内处理是有效安全的诊断和治疗手段,可降低孕妇和胎儿的风险。     

急诊输尿管镜钬激光碎石与体外冲击波碎石治疗输尿管结石并急性肾绞痛的疗效比较

目的比较急诊输尿管镜钬激光碎石（URL）与急诊体外冲击波碎石（ESWL）两种方法治疗输尿管结石引起的急性肾绞痛的疗效。方法2006年1月至2008年9月，采用Storz8／9F硬质输尿管镜、钬激光碎石机和DornierCompactS型低能量电磁式碎石机分别急诊治疗输尿管结石并肾绞痛175例和110例。所有病例均先行药物治疗症状无缓解后在急诊初诊12h之内接受急诊URL或急诊ESWL。结果对于输尿管上段结石，术后疼痛缓解率URL组虽优于ESWL组（93．94％和66．67％，P〈O．05），但碎石成功率（84．85％和83．33％，P〉0．05）及二周结石排净率（81．81％和77．78％，P〉0．05）均无显著差异。而对于输尿管中下段结石，术后疼痛缓解率（98．59％和92．39％）、碎石成功率（98．59％和91．30％）以及二周结石排净率（97．18％和94．78％）URL组均优于ESWL组fP〈0．05）。最大径10mm以内的结石URL组碎石成功率优于ESWL组（96．38和88．10％，P〈0．05）。最大径10mm以上的结石，术岳疼痛缓解率及2周排净率URL组均优于ESWL组（97．30％和69．23％，91．89％和61．23％，P〈0．05）。5RL及ESWL组并发症率分别为3．46％和2．73％（P〉0．05）。结论急诊URL和急诊ESWL均是输尿营结石并急性肾绞痛的安全、有效的治疗方法，对于输尿管上段结石或最大径不超过10mm的结石二首效果相当，而对于输尿管中下段结石或直径大于10rllm的结石来说，URL疗效优于ESWL。     

Ureteroscopy as a first-line intervention for ureteral calculi in pregnancy

BACKGROUND AND PURPOSE: Renal colic in pregnancy presents a diagnostic and therapeutic challenge. When conservative therapy fails or is not indicated, temporary measures such as ureteral stenting are often chosen as a first-line intervention, postponing definitive management until after delivery. We propose that advances in endoscopic equipment and anesthesia techniques dictate a more definitive strategy. PATIENTS AND METHODS: A retrospective analysis was performed on 10 consecutive pregnant patients presenting with renal colic necessitating intervention between April 1998 and April 2000. The mean patient age was 23 (range 17-31) years. One patient presented during the first trimester, six in the second, and three in the third. Four of the patients had a history of stone disease. All patients had flank pain at presentation, six on the left side and four on the right. Hematuria, fever, and nausea were present in eight, one and two patients, respectively. RESULTS: Ultrasound scanning was performed in all patients and showed a low sensitivity (28.5%) when compared with intraoperative findings. Ureteroscopy (rigid and/or flexible) was performed as a first-line intervention in six patients, in two of whom no stone was found. Percutaneous nephrolithotomy was carried out in one patient presenting with a nephrostomy tube. Double-J stents were placed in only three patients with specific indications, namely urinary infection, late gestational phase, and difficult ureteroscopy secondary to a narrow ureter. No obstetric or urologic complications were noted. The mean size of the stones retrieved in seven patients was 7 mm. CONCLUSIONS: Ureteroscopy may be considered a safe and effective first-line definitive therapeutic option in pregnant patients requiring intervention for stone disease.